GuidingCare tips: InterQual® and expedited authorization requests

Thank you for all the work you’ve done as we transitioned to our new authorization tool, GuidingCare. We’ve learned from you during the first week, and we want to share some tips to ensure quick processing of your authorization requests.

Tip #1: Allow pop-ups so you can answer InterQual® questions

It’s important to make sure you allow pop-up windows when using GuidingCare. GuidingCare will automatically access InterQual criteria for applicable services through a pop-up window prior to submitting your authorization. Closing the pop-up window without completing the InterQual questions will result a delay in the processing of your authorization. To ensure you have pop-ups turned on in Google Chrome (the preferred GuidingCare browser):

  1. Open Google Chrome.
  2. Click the triple dots in the upper right-hand corner of the screen. A drop-down list is displayed.
  3. Select Settings from the drop-down list. The setting page is displayed.
  4. On the left-hand navigation pane of the settings page, click Privacy and Security. The Privacy and Security settings options are displayed in the right side of the page.
  5. On the right side of the Privacy and Security page, click the arrow at the right end of the Site Settings. The Site Settings Page is displayed.
  6. Scroll down the Site Settings page and click the arrow at the right end of Pop-ups and redirects. The Pop-ups and redirects page is displayed.
  7. Click the Add button to the far right of the section. The Add a site pop-up is displayed.
  8. Enter in the Site field.
  9. Click the Add button to add Priority Health to the list of sights on which Google Chrome should allow pop-ups.
  10. Close the Chrome Settings browser tab to exit.

Tip #2: Use the correct authorization priority to ensure quick processing

There are several authorizations priorities you can choose when submitting your authorization. Choosing the wrong authorization priority can delay the decision for your request.

The Planned Admission Expedited priority should only be used when you have an elective service that needs to be scheduled emergently. Urgent/emergent refers to an instance when delaying the treatment would either: put the patient’s life in serious danger, interfere with full recovery, or delay treatment for severe pain.

For a list of authorization priorities and their definitions, use the following tables on our GuidingCare training and help page.

  • Behavioral health inpatient authorization priority definition
  • Behavioral health outpatient priority definition
  • Medical authorization priority definition

Tip #3: Make sure you’re reading GuidingCare alerts to ensure quick processing

We’ve had an increase in duplicate authorization requests. If an authorization was submitted prior to Sept. 14, you do not need to resubmit the authorization in GuidingCare. GuidingCare provides alerts when you submit an authorization that already exists in the system. Bypassing this alert and continuing with your submission with result in a delay in processing.